BETTER BEGINNINGS Healthy Families A Report on the Health of Women, Children, and Families in Spokane Amy S. Riffe, MA, MPH/Elaine Conley, Director Spokane Regional Health District Community Health Assessment, Planning, and Evaluation

Demographics – Spokane County 472,650 residents in ,470 women of childbearing age 5,867 births Births  8% years  59% years  31% years  2% years  47% Medicaid  90% White  11% <High school ed

Birth rate 12.4 per 1,000 residents Decreased from Lower than WA Teen birth rate, per 1,000 women No trend Similar to WA Demographics - continued

Cost of a Birth – Spokane County Full term infant  93% of full term ≤ 3 days  $6,800 Preterm infant  40% ≤ 3 days  $55,900  6.5% of births  64% of charges The average hospital stay for a newborn was 3 days The average charge was $10,000

POOR MENTAL HEALTH 17.0% of women No trend Similar to WA No difference by age Decreased with income Preconception Health

Pre-pregnancy obesity  24.1% obese before becoming pregnant  Increased from  Lower than WA  Increased with age  Higher for Medicaid  Higher for black, AIAN

Preconception Health Unintended pregnancy  36.1% of birth were unintended pregnancies  Similar to WA  Decreased with age  Higher for Medicaid  No difference by race

Family Health Family Structure, Spokane County, 2011  108,605 children 0-17 years  52,489 family households with children  23.4% were a female householder, no husband 6,196 children 0-5 years live with a single mother  8.7% were a male householder, no wife

Family Health ACEs  12% of kids K-6 have 3+  46% of women have 4-8  Higher than WA  No difference by age  Decreased with income Low social support  18.9% with low support  No trend  Similar to WA  No difference by age  Decreased with income

Family Health Child abuse  5,264 victims in 2011  Increased from  Higher than WA Smoking in home  16.9% allow it  No trend  Higher than WA  No difference by age  Decreased with income

Family Health Stressors  13.5% of mothers had 4+ stressors during  Higher for women  Higher for Medicaid  Higher for non-whites Women with 4+ stressors  Nearly 10x more likely to have postpartum depression  Almost 6x more likely to have a LBW infant

Maternal Health Short IPI  40.8% had a short IPI  Decreased from 07 to 11  Higher than WA  No difference by income or race  Decreased with age Prenatal care, 1 st tri  88.7% had 1 st tri PNC  Increased from 07 to 11  Higher than WA  Increased with age  Lower for Medicaid  Lower for non-white

Maternal Health Maternal smoking  15.9% smoked  Decreased from  Higher than WA  Decreased with age  Higher for Medicaid  Higher for black, AIAN Alcohol use  37.3% drank in last trimester  Similar to WA  No difference by age, Medicaid, or race

Child Health Low quality of life  23.7% of youth reported a low QOL  Decreased from 06 to 10  Higher for low education  Higher for blacks

Child Health Kindergarten readiness  Washington Kindergarten Inventory of Developing Skills  Fall 2012  Social/emotional  Physical  Language  Cognitive  Literacy  Math

Summary Better than WA  Dental sealants  Hypertension  Prenatal care first trimester  Pre-pregnancy obesity  Vaccine preventable illness Worse than WA  ACEs  Birth defects  Breastfeeding  Child abuse  Chlamydia  Immunization exemption  Maternal smoking  No flu shot in the last year  Short IPI  SIDS  Smoking allowed in home

Summary Good trend  Breastfeeding  Low quality of life  Maternal smoking  Prenatal care first trimester  Preterm birth  Short IPI  Vaccine preventable illness Bad trend  Child abuse  Chlamydia  Diabetes  Good general health  Hypertension  Immunization exemption  Pre-pregnancy obesity

Concerns Many of the indicators are getting worse Many of the measures show a disproportionate impact on: o Individuals on Medicaid o Racial minorities Many of the issues are deeply rooted in inequities such as: o Educational attainment o Household income o Neighborhoods in which people live

What Can We Do? Traditional public health approaches are not sufficient to address many of these problems Community wide initiatives that impact the root causes of these issues will need to be initiated and/or expanded

What Can We Do? (continued) Need a continuum of activities that address all levels of the socio-ecological model

What Can We Do? (continued) Focus on policy and system-level change while simultaneously focusing on social, organizational and individual behavior change We must develop a shared vision for the future of children and families in the community

Recommendations Four major areas of recommendations…..

Recommendations (Continued) Mitigate and/or prevent the impacts of ACEs on children and families  Build community resilience by promoting community connectivity  Support a variety of providers, organizations parents and community members in adopting trauma-sensitive practices in their work and in the community  Promote positive community norms about parenting programs and acceptable parenting behaviors

Recommendations (Continued) Mitigate and/or prevent the impacts of ACEs on children and families (Continued)  Continue to support best practice one-on-one interventions such as Nurse Family Partnership for the most vulnerable families  Invest in mental health resources  Strengthen safe, stable, nurturing relationships at the community level  Establish peer support models for expectants mothers  Build connectivity among women through low cost activities like exercise

Recommendations (Continued) Ensure That Children Enter School Ready to Learn  Develop and implement universal developmental screening for children 0-5 years of age.  Invest in quality early childhood education  Address the achievement gap between white and non-white students

Recommendations (Continued) Address Inequities in Spokane County  Promote policies that meet families’ basic needs including:  Affordable housing  Access to food  Access to health care  Provide adequate income support for young families  Increase minority representation on governing boards to assist in decision making that supports all people  Develop policies utilizing a child and family sensitive lens and advocate for a “health in all policies” standard